Healthcare Provider Details

I. General information

NPI: 1629376371
Provider Name (Legal Business Name): ANNETTE MARIE SCHILLE M.S., R.D., LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

14 KINGS ROW
NORTH READING MA
01864-1546
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6177
  • Fax: 617-730-0496
Mailing address:
  • Phone: 978-276-0545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberS54346004
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: